Seroprevalence and Risk Perception of TransfusionTransmissible Hepatitis among Voluntary Blood Donors in Western Nepal

( Bimala Sharma ),( Bishnu Raj Tiwari ),( Gyanendra Bikram Shah ),( Krishna Gurung ),( Mamita Khaling Rai ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The study aimed to assess the seroprevalence and risk perception of hepatitis B virus (HBV) and hepatitis C virus (HCV) among voluntary blood donors in the Western Region of Nepal. Methods: A total of 13,079 voluntary blood donors aged 18- 60 years attending from July, 2016 to June, 2017 were enrolled in the study. Perceived risk of HBV and HCV was measured by Likert-type scale: ‘no risk’, ‘little’, ‘moderate’, ‘high’ and ‘very high’ risk, ranging from 1 to 5. Blood samples were analyzed for the presence of HBsAg and HCV antibodies by ELISA at Western Regional Blood Transfusion Service Center. Proportion, mean, chi-square test and independent samples t-test were applied for statistical analysis. Results: Of the total, 83.8% participants were males; 88.2% were married; and mean age of the participants was 30.0 years. Seroprevalece of HBV was 0.3% in the total samples; 0.3% among males and 0.2% among females; and 0.5% among unmarried donors. Seroprevalece of HCV was 0.1% in the total; 0.1% among males and one case among females; 0.2% among unmarried; and 0.2% among those who ever pierced tattoo. No significant difference was observed in the seroprevalence of HBV and HCV among those who reported having multiple sexual partners and single sexual partner; and among Tattoo piercing and non-piercing respondents (P>0.05). Mean risk perception of HBV was slightly greater (x¯, 2.75; SD, ±1.24) than that of HCV (x¯, 2.68; SD, ±1.22). The mean risk perception of both types did not differ significantly across gender, age, marital status; and having multiple sexual partners and tattoo piercing practices (P>0.05). Conclusions: The study revealed low seroprevalence and low risk perception of HBV and HCV among voluntary blood donors in Western Nepal. Although the seroprevalence is low among voluntary blood donors, there might be higher prevalence of HBV and HCV in the community.

Public Health

( Bimala Sharma ),( Nirmala Shrestha ),( Nisha Gurung ),( Suresh Jaiswal ),( Bishnu Raj Tiwari ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Hepatitis C virus (HCV) infection is a public health problem in Nepal. The objective of the study was to assess the knowledge of hepatitis C virus infection among health science students of Pokhara University, Pokhara, Nepal. Methods: A cross-sectional study was conducted among health science students of Pokhara University in Pokhara, Nepal. A self-administered structured questionnaire was prepared and administered among students to collect information on socio-demographic and HCV infection. Two hundred students from Laboratory science, Pharmacy, Public health and Nursing disciplines were enrolled in the study. The data was collected from January to February, 2020. Mean knowledge score of HCV was measured from 29 questions related to it, in which each correct answer was coded 1 and incorrect answer as 0, resulting the maximum of 29, as it was measured in previous studies. Frequency, mean, chi-square test, and independent sample t test, one- way ANOVA were computed. Level of significance was set at 5%. Results: Of the total 200 students, 25.5% respondents were males; and median age of the participants was 21 years ranging from 17 to 26 years; 95% respondents were unmarried. Of them, 12.5% had ever made tattoo piercing and 25.5% had ever donated blood in their lives. Mean knowledge score of HCV was 19.28 (SD±3.00) out of 29 maximum, as measured from 29 questions. The mean knowledge score of HCV was 19.34 (SD ± 2.95) among females and 19.10 (SD ±3.18) among males; there was no significant difference in the mean knowledge score between males and females (p value >0.05). In addition, there was no significant difference in the mean knowledge score among the students of different programs of health science (p value >0.05). Regarding the individual questions, 93.5% respondents reported that hepatitis C is caused by a virus. Among all, 16.0% respondents agreed that HCV can be spread by mosquitoes; 37.5% believed that it can be spread through close personal contact such as kissing or talking; 89% respondents agreed that hepatitis C can be spread through sharing injecting equipment, such as needles and operation tools; and 74% respondents mentioned that sexual transmission is a common way of HCV transmission. Of the total, 53.5% agreed that having a medical and/or dental procedure increases a person’s chances of contracting hepatitis C; 41.7% students believed that symptoms appear soon after the entrance of HCV into the body; 55.5% agreed that symptoms always appear after the entrance of HCV to the body. Of total, 82% agreed that hepatitis C virus is associated with an increased risk of liver cancer; 83% mentioned hepatitis C can lead to liver cirrhosis; and 62.5% agreed that HCV is a mutant virus. Among total, 35.5% agreed that people with HCV infection should be restricted from working in the food industry; 65.5% agreed that special diet is recommended for patients with HCV; and 63% respondents mentioned that there is a vaccine for the prevention of HCV infection. Conclusions: The overall mean knowledge score of HCV infection was found satisfactory; however knowledge on some specific items/questions, especially on prevention and treatment related questions seemed impaired. Comprehensive information about all aspects of HCV infection should be provided to all students of health science.

네팔의 자살과 자살 예방 정책에 관한 연구

( Bimala Sharma ),김하윤 ( Ha Yun Kim ),김진리 ( Jin Ri Kim ),남은우 ( Eun Woo Nam ) 대한보건협회 2018 대한보건연구 Vol.44 No.3

연구목적 : 네팔과 같은 개발도상국가에서도 자살문제는 상당한 국가적 재난과제이다. 이 연구는 네팔의 자살 시도 현황과 자살 방법 및 이유 등에 대한 현황을 살펴보고 및 자살 예방 정책을 파악하는데 있다. 연구방법 : 게재된 논문 및 보고서를 내용분석 방법에 의해 분석하였다. 연구결과 : 네팔의 자살률은 인구 10만 명당 8.6~24.9명으로 세계 표준화 자살률인 10만 명당 11.4명보다 두 배 이상 높다. 그러나 네팔은 자살에 관한 신뢰할 수 있는 국가 데이터가 상당히 부족한 상태이다. 자살 시도 및 자살 사례가 과소보고 되는 주요 이유는 자살 사례의 오분류, 법적 및 보건부문 간의 협력 부족, 낙인, 인식 부족, 법적 조항 및 미흡한 사망 등록 시스템 등 때문이다. 대부분의 연구는 자살 사례에 대한 부검 보고서 또는 고의적인 자해에 대한 기관 보고 자료를 분석하였다. 그 결과, 목을 매달거나 약물중독으로 인한 사망은 자살의 90% 이상을 차지했으며, 살충제 약물 중독이 자살의 가장 큰 원인으로 나타났다. 여성과 청소년, 특히 20세에서 35세 사이의 자살 사망 및 자살 시도 사례가 더 빈번하게 보고되었다. 정신 건강 정책은 전 국민을 위한 기본적인 정신 건강 서비스 접근성 보장, 정신 건강에 대한 필요한 인력 개발, 정신 건강 인식 제고를 위해 1997년에 채택되었다. 그러나 그 시행은 효과적이지 못하다. 정신건강법은 2006년에 기안 되었으나 아직 정부의 승인을 기다리고 있다. 결론 : 네팔에서의 자살 사망 및 자살 시도 등의 문제는 많았지만 이에 비해 자살 예방에 대한 관심과 우선순위는 낮은 것으로 나타났다. 네팔은 정신건강 정책과 정신건강 서비스의 일부 조항은 존재하지만 구체적인 자살 예방 대책은 부족한 것으로 평가되었다. Objective : Suicide is a disaster of unknown magnitude in developing countries such as Nepal. This review aimed to explore suicide and suicide prevention policies in Nepal. Methods : Published articles and other reports were reviewed using content analysis. Results : The estimated suicide rate in Nepal is between 8.6 to 24.9 per 100,000 populations, which is more than double that of the global age-standardized suicide rate of 11.4 per 100,000. However, there is a severe shortage of reliable, representative, and nationwide data about the burden of suicide in Nepal. The major reasons for the underreporting of suicidal attempt and cases include the misclassification of cases, lack of coordination between the legal and health sectors, stigma, a lack of awareness, legal provisions, and poor death registration systems. Most of the studies were institution-based using either autopsy reports of suicide cases or cases of deliberate self-harm. Hanging and poisoning accounted for more than 90% of suicides; and organophosphorus poisoning was the most common cause of poisoning. Suicide and suicide attempts were more frequently reported in women and young people, especially among those between 20 and 35 years of age. A mental health policy was adopted in 1997 with the objective to ensure accessibility of basic mental health services for all; to develop required manpower; and to improve awareness about mental health. However, its implementation has not been effective. The Mental Health Act was drafted in 2006, but its endorsement by the government is also pending. Conclusions : The suicide burden in Nepal seems alarming but receives far less attention and priority. Although there is a mental health policy and some provision of mental health services, no specific suicide prevention strategies are developed.

Factors Associated with Happiness among Senior Citizens of Rural Korea: Evidence from the 2017 National Survey of Older Koreans

Bimala Sharma,송그룸,남은우 한국보건행정학회 2020 보건행정학회지 Vol.30 No.2

Background: Happiness is one of the most important indicators of health, wellbeing, and quality of life among older adults. The objective of the study was to investigate factors associated with happiness among senior citizens residing in rural areas using the 2017 National Survey of Older Koreans. Methods: A cross-sectional analytical study was conducted among 3,149 senior citizens living in rural areas using secondary data from the 2017 National Survey of Older Koreans. Happiness was measured by a single question and responses were recorded dichotomously. Descriptive and inferential statistics were computed at a 5% level of significance. Results: In all, 64.5% of the participants considered themselves as happy most of the time in the last 1 week. In the study, socio-demographic factors did not predict happiness except age. Satisfaction with a health status, financial situation, relationship with children, cultural satisfaction, and satisfaction with friends and society were positively associated with happiness among senior citizens residing in rural areas of Korea. Odds of reporting happiness were higher among those who traveled in the last 1 year, visited elderly welfare centers, and were involved in voluntary work than among those who did not. Conclusion: Happiness among senior citizen was significantly associated with life satisfaction with regard to health, finance, relationship with family, friends and society, and social activity participation.

이중차이분석을 이용한 KOICA 페루 학교건강증진 사업의 청소년 정신건강사업 효과

이재원,Bimala Sharma,조혜연,남은우 한국보건교육건강증진학회 2019 보건교육건강증진학회지 Vol.36 No.3

Objectives: The aim of this study is to analyze the effects of mental health projects of KOICA-Yonsei school health promotion project in Peru. Methods: The project was implemented in Comas and Callao, Lima, Peru from 2014 to 2017 by KOICA-Yonsei School Health project team. The intervention and control schools were four and two, respectively. Difference in differences and logistic regression analysis were performed using the results of Baseline and Endline surveys conducted in 2014 and 2017. Mental health indicators were used for the evaluation of the project in the study. Results: The Difference in Differences analysis showed that the proportion of depression, suicidal thought, being in fight and physical abuse was reduced by 11%, 7.3%, 6.9% and 4.1%, respectively. The logistic regression analysis revealed that there was significant improvement in physical abuse and alcohol consumption. There was significant reduction in being in the fight, intimidation in last 30 days, physical abuse by friends and alcohol consuming in last 30 days in both intervention and control group. However, the proportion of reduction was higher in the intervention group. Conclusions: The school mental promotion project could be useful intervention for students to improve mental health status. Therefore, it is necessary to develop and implement integrated programs to improve school mental health.

Health Related Quality of Life and Associated Factors among pregnant and mothers of under five children in Kwango District, DRC

김연희,Bimala Sharma,남은우 사단법인 대한보건협회 2019 대한보건연구 Vol.45 No.4

Background: Improving the quality of life is a major goal in the provision of health. The study aimed to identify level of quality of life and associated factors with it among pregnant and mothers of under five children in the Kwango district of the Democratic Republic of the Congo. Methods: A total of 1,333 pregnant women and mother of under five children age. In the total of 719 pregnant women and mother of under five children in the Kenge area and 614 in the Boko area, were selected for the study in 2017. As primary outcome, EuroQol 5Dimension was measured with respect to mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each domain was subdivided into three categories 1) no problem, 2) some problem and 3) problem if of these questions answered that there was a problem, they were defined as problematic. Descriptive statistics, chi-square test and logistic regression analysis was performed to analyze whether general and medical service-related characteristics affect quality of life. Result: In total, 302 (22.7%) individuals reported to have at least one problem. Education, income level, perceived quality of hospital services, hospital services utilization and post-partum problem were significantly associated quality of life. Conclusion: Official Development Assistance (ODA) projects in the Democratic Republic of Congo are required not only for the maternal health projects but also policies to raise education and income in order to improve the quality of life related to women’s health.

Senior Citizen Centers Utilization: Role of Socio-Demographic Factors, Life Satisfaction and Health Condition in Korea

Geurum Song(송그룸),Bimala Sharma,Eun Woo Nam(남은우) 한국농촌의학 지역보건학회 2020 농촌의학·지역보건 Vol.45 No.3

목적: 한국은 지역사회 기반 통합 돌봄(커뮤니티케어)을 통해 노인들을 위한 보건 및 사회복지 서비스의 확대를 추진하고 있다. 본 연구는 노인의 경로당 이용에 대한 인구사회인적 요인, 삶의 만족도, 건강상태 등이 미치는 영향을 파악하고자 한다. 연구방법: 2017년 노인실태조사 자료를 이용하여, 횡단 분석 연구가 실시하였다. 이용패턴을 파악하기 위해 기술통계를 하였고, 경로당 이용과 관련된 요소들을 결정하기 위해서는 다변량 로지스틱회귀분석을 실시하였다. 연구결과: 지난 12개월간 노인 1만299명 중 22.7%가 경로당을 이용하였다. 경로당을 이용하는 이유 중 가장 많은 응답은 경로당 동료들과 여가를 보내기 위함이었으며, 대상자의 95% 이상이 제공되는 서비스에 만족하고 있었다. 사회인구학적 특성에 대해서는 여성(AOR=1.20; 95% 신뢰 구간(CI), 1.05-1.38), 80세 이상 노인(AOR= 3.94, 95% CI, 3.30-4.71), 문맹자(AOR=5.27; 95% CI 3.80-7.30), 교육 수준이 낮거나 읍면 지역 출신(AOR=6.42; 95 % CI, 5.72-7.20)이 경로당을 이용할 가능성이 가장 높았다. 생활만족도 부분에서는 재정적 만족도(AOR=1.21; 95% CI, 1.06-1.37), 문화에 대한 만족도(AOR=1.49; 95% CI, 1.24-1.79) 및 친구들과 사회에 대한 만족도(AOR=4.24; 95% CI, 3.17-5.66)가 높은 사람이 경로당을 더 많이 이용하는 것으로 나타났다. 질병이 없다는 응답자에 비해 만성 질환을 2개 이상 보유한자(AOR= 2.01; 95 % CI, 1.60-2.53)의 경로당 이용률이 2 배 더 높았다. 결론: 정부의 지역사회 기반 통합돌봄 정책 수립을 위하여 경로당 이용에 영향을 미치는 인구사회학적요인, 삶의 만족도, 건강상태와 관련된 요인들을 고려하여, 이용률을 높이고, 건강관리를 위한 통합돌봄 시설이 될 수 있도록 하여야 할 것이다.

Determinants of Primary Health Care Utilization in Ethiopia

김도형,남은우,Kidist Birmeta,김철수,Bimala Sharma,Sarita Dhakal,이호철 연세대학교(미래캠퍼스) 빈곤문제국제개발연구원 2016 地域發展硏究 Vol.25 No.특별호

In Ethiopia, primary health care services utilization remains low and irregular. This study attempted to assess utilization and associated factors in Holeta Town, Oromia region, Ethiopia. A cross sectional survey was conducted among randomly selected 1,422 households. Multivariate logistic regression analysis was applied to calculate crude and adjusted odds ratios(aOR) at 5% level of significance using Andersen model. The primary health care services utilization was 60.0%. Logistic regression analysis revealed predisposing factors: Gurage ethnicity (aOR=0.48), being married (aOR=1.53), and having favorable attitudes towards health services (aOR=1.74); enabling factors: monthly income of 501-1,000 birr (aOR=1.51), and not having health insurance (aOR=1.89); and need factor: absence of experience of illness (aOR=0.48) that determined primary health care utilization. Primary health care utilization was influenced by predisposing, enabling, and need factors, concerned authorities should focus on the needs of low-income households, improving their socio-economic status, and strengthening primary healthcare services to promote utilization.

Knowledge of Hepatitis B Virus Infection among Health Science Students of Pokhara Univ., Gandaki Province, Nepal

( Bishnu Raj Tiwari ),( Suresh Jaiswal ),( Sanju Bastola ),( Bimala Sharma ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Hepatitis B virus infection (HBV) is public health problem in Nepal. The prevalence of HBV was found to be below 1% (0.9%), however some subgroup of population showed high prevalence by various studies. The study aimed to determine the knowledge of Hepatitis B virus infection among health science students of Pokhara University, Nepal. Methods: A cross-sectional survey was done among 200 students of health and allied science of Pokhara University using a structured self-administered questionnaire method. The questionnaire was prepared based on the previous studies. Students from public health, laboratory science, pharmacy and nursing disciplines were enrolled in the study. The information was collected from January to February, 2020. Mean knowledge score of HBV was measured based on 28 related questions as it was done in previous study, in which each correct answer was coded 1 and incorrect answer as 0, resulting the maximum score of 28 for all right answers. Descriptive statistics, and chisquare test, independent sample t test and one -way ANOVA test were applied. Results: Of the total, 74.5% of the respondents were females; and mean age of the respondents was 20.6 (SD ±1.48) years. Mean knowledge score of HBV was 19.48 (SD±2.72) out of 28. The mean knowledge score was 19.90 (SD± 2.67) among females and 18.33 (SD±2.53) among males; there was significant difference in the mean knowledge score between males and females (p value <0.05). Similarly, there was also significant difference in the mean knowledge score among the students of different disciplines of health science (p value <0.05); the highest mean was observed among nursing students which was 21.22 (SD+2.64). Regarding the individual questions, 98% respondents agreed that hepatitis B infection is caused by a virus. Among all, 16.5% respondents agreed that hepatitis B infection can be spread by mosquitoes; the statement was significantly different by sex (P<0.05). Of the total, 41.9% agreed that hepatitis B can be spread through close personal contact such as kissing or talking, 29.5% agreed that sharing dishes with HBV positive patients can cause the spread of virus; 97% reported that hepatitis B is spread through blood-to-blood contact; and 86.5% respondents mentioned that sexual transmission is a common way hepatitis B is spread. Of total, 91% students agreed that there is a vaccine for HBV. Among all, 84% students agreed that HBV is associated with an increased risk of liver cancer and 87.5% mentioned that HBV can lead to liver cirrhosis. Of the total, 58.5% agreed that having a medical and/or dental procedure increases a person’s chances of contracting HBV; 69.5% students believed that symptoms appear soon after the entrance of HBV into the body; 55.8% agreed that symptoms always appear after the entrance of HBV to the body; 38.5% students agreed that people with HBV should be restricted from working in the food industry; and 64.5% students reported that there is a pharmaceutical treatment available for hepatitis B; and the agreement with all the above statements had statistically significant association with sex (p value <0.05). Conclusions: The mean knowledge score of HBV infection was found satisfactory among health science students of Pokhara University, Gandaki province, Nepal. Significant differences were observed in the mean knowledge score of HBV by sex and different disciplines of health science. The curriculum of all health science disciplines should be comprehensive to cover all aspect of HBV infection